Thursday, May 13, 2010

Anesthesiologists Are Lone Wolves

The Journal of the American Medical Association has printed a very personal and touching essay from a cardiologist in Pennsylvania. It is also highlighted in the Well Blog of the New York Times. The physician, Dr. Ram Gordon, describes in a series of letters his evolving relationship with a patient that ultimately led to much more than a clinical doctor/patient interaction.

This got me to thinking how anesthesiologist will rarely, if ever, have this kind of relationship with our patients. Do I miss it? I must admit that I got misty-eyed reading that beautiful essay by Dr. Gordon, but in reality, not really. First of all, having a deeply personal relationship with patients is extremely rare as Dr. Gordon himself alludes to. I bet he has at most one or two other patients in his whole office that he has shared his personal information. Most patients come in complaining about this or that symptom and could care less that you have three children in school and one of them just got a blue ribbon in 4H for pig raising. And let's face the truth; we anesthesiologists see a patient for ten minutes before a case and maybe another ten minutes in recovery. That time constraint is not conducive to developing a meaningful rapport with the patient and his family.

The subspecialty fields in anesthesiology where you might have more face time with patients also aren't likely to blossom into a beautiful relationship. Critical Care patients are usually too sick or sedated to share their family stories with you. Pain Medicine patients just want drugs. They'll tell you any story you want as long as you renew their prescriptions.

So I guess I'm destined to go through life without ever having an extraordinary bond with a patient that is worth writing about in the NY Times. But I suspect that this kind of interaction with patients will become increasingly rare as doctors hustle to see more patients due to cuts in reimbursements. And if physicians become employees of large hospital organizations, as some cost cutters advocate, you can forget about having any bonding that does not benefit the employer. After all, when was the last time you had a deeply personal conversation with your post office clerk?